日東医誌 Kampo Med Vol.59 No.

6 783-792, 2008 783

Original Article

Development and Validation of the Japanese

Version of the Constitution in Chinese
Medicine Questionnaire (CCMQ)
Yanbo ZHUa＊ Hideki ORIGASAb Kazuo UEBABAc
Fenghao XUc Qi WANGd
a School of Administration, Beijing University of Chinese Medicine, Beijing 100029, China
b Division of Biostatistics and Clinical Epidemiology, University of Toyama School of Medicine and Pharmaceutical Sci-
ences, Toyama 930-0194, Japan
c International Research Center for Traditional Medicine, Toyama 939-8224, Japan
d School of Preclinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China

体質に関する CCMQ 質問票日本語版の臨床開発とその妥当性の検証

朱 燕波a＊ 折笠 秀樹b 上馬場 和夫c
許 鳳浩c 王 ! d

a 北京中医薬大学管理学院，中国，北京１
０００
２９，北京市朝陽区北三環東路１ １号
b 富山大学医学薬学研究部バイオ統計臨床疫学，富山，〒９ ３
０‐０
１９４ 富山市杉谷２６３
０
c 富山県国際伝統医学センター，富山，〒９３９
‐８２２
４ 富山市友杉１５１
d 北京中医薬大学基礎医学院，中国，北京１００
０２９，北京市朝陽区北三環東路１ １号

Abstract
Objectives : The objective of this study is to develop a Japanese version of the Constitution in Chinese Medi-
cine Questionnaire (CCMQ) in Chinese, which is comprised of 60 items with 9 sub-scales, and evaluate its re-
liability and validity. Methods : We conducted a survey of 130 participants in the Toyama area of Japan from
Dec. 2005, to Feb. 2006. A test-retest method was used. Feasibility was evaluated by the response times to
the questionnaire, and the response rates of the CCMQ items. Internal consistency within the sub-scales was
assessed by Cronbach’s α coefficient. Reproducibility was confirmed between the first and second occasions
using weighted kappa and Spearman correlation. Lastly, criterion validity was evaluated by correlation be-
tween CCMQ and SF-36 sub-scales. Results : Response time was 8 minutes on average and its rate was
nearly 100%. Internal consistency was achieved for each of the 9 sub-scales with a 0.65 to 0.79 α coefficient.
Reproducibility ranged from 0.41 to 0.81 for the items, and from 0.79 to 0.88 for the sub-scales. Regarding the
criterion validity, the “Gentleness type” sub-scale was positively correlated with SF-36 (0.46, P<0.001), while
other 8 pathological constitutional types of the CCMQ were negatively correlated with SF-36 (-0.35 to -0.50, P
<0.001) as expected. Conclusions : We developed a Japanese version of the CCMQ and found acceptable lev-
els of reliability and validity using a survey of 130 subjects in Japan. This suggests that the CCMQ could be a
useful tool in comparing the constitution profiles between Chinese and Japanese.
Key words: Constitution, CCMQ, Qi-deficiency type, Yang-deficiency type, reliability, validity

要旨
目的：本研究の目的は中国語版体質に関する質問票（CCMQ）の日本語版を開発することである。この質問票は
全部で６
０問あり，９つの下位尺度（平和質・気虚質・陽虚質・陰虚質・痰湿質・湿熱質・ 血質・気鬱質・特稟質， !
ここで平和質を除く８体質は病理体質）に分けられる。この質問票に対して，信頼性と妥当性を検証することを目
標とする。 方法：２
００５年１
２月から２
００６年２月にかけて，富山市内の１
３０名の住民に対して Test-retest 法を用い
て調査を実施した。質問票の許容性は回答時間と回答率で評価した。内部妥当性は下位尺度ごとにクローンバック
α 係数で検討し，１回目と２回目の回答に関する再現性は重み付けカッパ係数とスペアマン相関係数で検討した。
基準連関妥当性は，本質問票の CCMQ と包括質問票として著名な SF−３
６下位尺度との相関係数で評価した。
結果：回答時間は平均８分であり，回答率はほぼ１
００％であった。９つの下位尺度に関する α 係数は０．
６５から０．
７９
であった。再現性は各質問につき０．
４１∼０．
８１であり，下位尺度については０．
７９∼０．
８８と優れていた。基準連関妥当
性については，予想通り，正常体質である平和質型と SF−３
６とは正の相関を示し（r＝０．
４６，P＜０．
００１）
，病的体

＊Corresponding author : Yanbo ZHU

Received 18 September 2007, Accepted 11 July 2008
784 日東医誌 Kampo Med Vol.59 No.6. 2008
質である残り８つの体質型と SF−３
６とは負の相関を示した（−０．
３５∼−０．
５０，P＜０．
００１）
。
結論：中国語版体質に関する質問票（CCMQ）の日本語版を開発し，その信頼性と妥当性を１
３０名の住民に対し
て立証した。今後，日中間において体質研究を行う際，この質問票は有用な道具になることが期待される。
キーワード：体質，CCMQ 質問票，気虚質，陽虚質，信頼性，妥当性
Ⅰ．Introduction
The constitution in Chinese medicine is based on
an individuals’ inherited constitutions and their life-
styles, geographic and climatic environment which
are acquired. The constitution greatly affects our
health and disease ; therefore it is necessary to make
a questionnaire to quantify the constitution in a sci-
entific way.
Western medicine has categories like Short and
Fat type, Thin type and Medium type. In Chinese
medicine, from ancient to now, there were many
categories about constitution, in ancient times has
classification of 25 types, in modern times has clas-
sifications of 4, 5, 6, 7, 9 and 12 constitution
types１）２）. Wang’s 9 classification of constitution for
general populations from numerous observations for
past few decades was proved to be clinically useful
and also practical. Their categories were classified
by Gentleness type（平和質） ，Qi-deficiency type
（気虚質） ，Yang-deficiency type（陽虚質） ，Yin-
deficiency type（陰虚質） ，Phlegm-wetness type
（痰湿質） ，Wet-heat type （湿熱質） ，Blood-stasis
!
type（ 血質） ，Qi-depression type（気鬱質）and
Special diathesis type（特稟質） . Excluding Gentle-
ness type, eight of the constitutions are classified
into pathological constitution（病的体質）types２）∼４）.
Therefore, based on the concept of 9 sub-scales of
constitution, Wang and colleagues has developed a
new questionnaire comprised from 60 questions in a
standardized way５）∼８）. The development of ques-
tionnaire is mainly applied to the health promotion
and clinical practice especially in traditional Chi-
nese medicine. It may also be useful in clinical
evaluation of traditional Chinese medicine and ap-
plicable for Kampo and other medicines. We se-
lected Wang’s questionnaire since it was well ap-
plied shown in above and psychometrically tested.
This is the reason that Wang’s questionnaire was
translated into Japanese through a pilot study. The
objective of this study is to evaluate the feasibility,
reliability and validity of the Japanese version of
CCMQ questionnaire using a psychometric test.
Ⅱ．Methods
１．Development of a Japanese Ver-
sion of the CCMQ
The CCMQ was developed by Wang and his col-
leagues in 2004 to 2005. It was a self-administered
questionnaire comprised from 9 sub-scales of Gen-
tleness type, Qi-deficiency type, Yang-deficiency
type, Yin-deficiency type, Phelgm-wetness type,
Wet-heat type, Blood stasis type, Qi-depression type
and Special diathesis type. Each sub-scale consisted
of 7 to 9 individual questions and ended up with 60
questions. Some of the questions apply to both of
the two sub-scales. For example : Question 2 “Do
you get tired easily?” pertains to both the Gentle-
ness type and the Qi-deficiency type. The meaning
of each sub-scale was shown on Table 1. Each
question was answered by choosing one from the
Likert scale on the grade of 5 scales as Never , !
" # $
Rarely , Sometimes , Often and Always . In %
each sub-scale, the points were summed up for each
person. Sub-scale summary score was standardized
from 0 to 100 by using the formula as (Sum-Lowest
score)/(Highest score-Lowest score) multiplied by
100. The higher the score was, the stronger the con-
stitution type was.
First, a panel of Chinese experts translated the
CCMQ into Japanese. Then, a pilot survey using it
was conducted on the seven subjects. After moder-
ating several problems, a panel translated again it
into Japanese. Its version was now reversely trans-
lated into Chinese by a different panel of experts.
Thus, a final Japanese version was completed. A pi-
lot survey was now conducted on the seven subjects
and the quality of the questionnaire was verified and
finalized.
２．Subjects
Those who were asked to participate in the survey
were attendees of utilizing the Health Park con-
nected to the International Center for Traditional
Medicine in Toyama. This survey was conducted
for a total of 130 persons and they were selected
considering the balance of age and sex strata. Par-
ticipants were over 20 years of age and written in-
formed consent was obtained from each person.
Those excluded were :
１）Those with mental sicknesses and those with
behavioral problems.
２）Those with serious illnesses.
３）Those who could not understand the ques-
tionnaire.
４）Those who would not consent to answering
 日東医誌 Kampo Med Vol.59 No.6. 2008
Table 1 Nine sub-scales of the CCMQ and their meanings
the questionnaire.
３．Contents of the Questionnaire
! CCMQ – We used the Japanese version of
the CCMQ shown in the Appendix to conduct this
research.
" QOL Questionnaire – In order to evaluate
criterion validity, we conducted the survey of SF-36
(Japanese version) which includes physical and
mental component summary (abbreviated by PCS
and MCS later) at the same time. Scores rang from 0
to 100, with higher scores indicating better subjec-
tive health status９）１０）.
# Background – We asked age, sex, academic
career, occupation, and marital status of the subject
at baseline.
４．Design
This survey was held from December 2005 to
February 2006. After receiving a written consent
785
from all the participants, the questionnaire was con-
ducted either on a personal interview basis or ex-
plained over the telephone. The test and re-test
method was utilized with an interval of one to four
weeks on the same contents of the questionnaire.
This study was approved by the University of
Toyama Ethical Committee in advance.
５．Statistical Analysis
Values were presented as mean ± standard devia-
tion. Feasibility was evaluated by the response time
to the questionnaire and the response rate of each
item. Internal consistency was evaluated by Cron-
bach’s alpha coefficient for each of the 9 sub-scales.
Reproducibility was evaluated by the weighted
kappa coefficient for each question and Spearman
correlation coefficient for each sub-scale. Criterion
validity was assed by the comparison with SF-36,
PCS and MCS of the SF-36. Statistics Analysis was
786 日東医誌 Kampo Med Vol.59 No.6. 2008

Appendix. Japanese version of the Constitution in Chinese Medicine

Questionnaire (CCMQ)
体質に関する調査票

この調査票はあなたの体質に関する状況を調べ，今後の健康管理
や診療に参考にさせていただく目的で使われるものです。一つ一つ
の項目をよく読んで，最近１年間のあなたの状況や感じに最もよく
あてはまる番号をひとつだけ選び，○で囲んでください。答えにく
い場合には，最も近い状況にあてはまる答えを選んでください。
すべての項目は最近１年間の状況を答えてください。また項目ご
とに，１つだけ○をつけてください。

最近の１年間にあなたが，以下の質問について，どの まった まれに ときど よく いつも

ぐらい経験しましたか くない ある きある ある ある
¸ 元気がありますか １ ２ ３ ４ ５
¹ 疲れやすいですか １ ２ ３ ４ ５
º 息切れをしますか １ ２ ３ ４ ５
どう き
» 動悸（脈拍が早い）がしますか １ ２ ３ ４ ５
¼ めまいや立ちくらみをしますか １ ２ ３ ４ ５
½ 物静かで，人と話すのが苦手のほうですか １ ２ ３ ４ ５
¾ 話し声が弱弱しいですか １ ２ ３ ４ ５
¿ 物忘れをしますか １ ２ ３ ４ ５
ゆううつ
À 憂鬱で，気が沈む感じがしますか １ ２ ３ ４ ５
Á 精神が緊張して，イライラしますか １ ２ ３ ４ ５
かんしょうてき
 感 傷 的で，涙もろいですか １ ２ ３ ４ ５
à 特に理由もなく，恐ろしいと感じますか １ ２ ３ ４ ５
わき
Ä 胸や脇が張ったり，痛んだりしますか １ ２ ３ ４ ５
Å 胸が詰まって重苦しい感じがしますか（特に湿気っ
１ ２ ３ ４ ５
ぽい天気時に）
Æ 何の理由もなく，ため息をつきますか １ ２ ３ ４ ５
Ç 体と手足が重だるく感じますか １ ２ ３ ４ ５
È 手のひらと足の裏がほてりますか １ ２ ３ ４ ５
É 夏でも手足が冷えますか １ ２ ３ ４ ５
こし ひざ
Ê 腰や膝が冷えますか １ ２ ３ ４ ５
あつ ぎ
Ë 寒がりで，ほかの人より厚着を好みますか １ ２ ３ ４ ５
Ì 顔や身体のほてりを感じますか １ ２ ３ ４ ５
Í ほかの人より，冬の寒さに弱いですか １ ２ ３ ４ ５
Î ほかの人より風邪を引きやすいですか １ ２ ３ ４ ５
Ï 風邪を引いていないのに，くしゃみが出ますか １ ２ ３ ４ ５
Ð 風邪を引いていないのに，鼻水が出ますか １ ２ ３ ４ ５
はな つ
Ñ 風邪を引いていないのに，鼻詰まりますか １ ２ ３ ４ ５
Ò 暑さ・運動・厚着にかかわらず，汗をかきやすいで
１ ２ ３ ４ ５
すか
Ó 汗が出やすく，べっとり感がありますか １ ２ ３ ４ ５
Ô 手のひらと足の裏に，汗をたくさんかきますか １ ２ ３ ４ ５
 日東医誌 Kampo Med Vol.59 No.6. 2008 787

最近の１年間にあなたが，以下の質問について，どの まった まれに ときど よく いつも

ぐらい経験しましたか くない ある きある ある ある
Õ 過敏症（薬，食べ物，花粉など）ですか １ ２ ３ ４ ５
じん ま しん
Ö 皮膚に蕁麻疹ができやすいですか １ ２ ３ ４ ５
むらさきいろ はんじょう
× 過敏で，皮膚に紫 色のまだら（点状・斑 状の出血） １ ２ ３ ４ ５
が出ますか
Ø 気がつかないうちに，皮膚に青あざができますか １ ２ ３ ４ ５

Ù 皮膚を "くと赤くなり，"いた跡がつきますか
か か
１ ２ ３ ４ ５
Ú 皮膚が乾き気味ですか １ ２ ３ ４ ５
Û 皮膚が荒れやすいですか １ ２ ３ ４ ５
Ü 体のあちこちが痛みますか １ ２ ３ ４ ５
ほお
Ý 顔の頬のあたりが赤い（ほてり）ですか １ ２ ３ ４ ５
Þ 顔や鼻がべとついたり，テカテカに光っていますか １ ２ ３ ４ ５
ß 顔色がさえないですか １ ２ ３ ４ ５
à にきびや吹き出物ができやすいですか １ ２ ３ ４ ５
まぶた
á 瞼がはれぼったいですか １ ２ ３ ４ ５
â 目の下にくまがありますか １ ２ ３ ４ ５
ã 目の乾燥感がありますか １ ２ ３ ４ ５
ä 目が充血しますか １ ２ ３ ４ ５
のど かわ
å 口または咽が渇きますか １ ２ ３ ４ ５
のど
æ 咽に何か詰まっている感じがしますか １ ２ ３ ４ ５
こうしゅう
ç 口の中に口 臭や苦い感じがしますか １ ２ ３ ４ ５
è 口の中がねばつきますか １ ２ ３ ４ ５
é いびきをかきやすいですか １ ２ ３ ４ ５
たん
ê 痰がたくさん出ますか １ ２ ３ ４ ５
ë 冷たいものをとると，体調を悪くしますか １ ２ ３ ４ ５
じゅくすいかん
ì 熟 睡感がありますか １ ２ ３ ４ ５
í 寝つきが悪いですか １ ２ ３ ４ ５
î 下痢をしますか １ ２ ３ ４ ５
ï 大便が粘ついて，排便後，さっぱりしない感じがし
１ ２ ３ ４ ５
ますか
ð 大便が硬くて，便秘しやすいですか １ ２ ３ ４ ５
ñ 尿の回数と量は多く，色が薄いですか １ ２ ３ ４ ５
ò 排尿するとき，尿道に熱さを感じ，濃い尿が出ます
１ ２ ３ ４ ５
か
ó おりものの色が黄色いことがありますか（女性のみ
１ ２ ３ ４ ５
回答）

ó
いんのう
陰 !が湿っぽい感じがしますか（男性のみ回答） １ ２ ３ ４ ５

あなたは全部の項目を，何分で回答できましたか
約（ ）分

ご協力ありがとうございました。もう一度記入もれがないかどうか確かめてください。
788 日東医誌 Kampo Med Vol.59 No.6. 2008

Table 2 Basic characteristics of the participants in the study

Table 3 Score distribution of the nine sub-scales of the Japanese CCMQ

 日東医誌 Kampo Med Vol.59 No.6. 2008
Table 4 Reproducibility of nine sub-scales and sixty questions
performed by SAS 8.2 and JMP 5.0.l J and the sig-
nificant level was set as P<0.05.
Ⅲ．Results
The response rate was 96% at the first test and
93% at the re-test occasion. Since two subjects did
not answer more than 14 questions at the first time
of test, their data were excluded. Therefore, the re-
sult was shown on the basis of data from a total of
123 subjects.
１．Background of Subjects
The 123 questionnaires received were from 49
men (39.8%) and 74 women (60.2%). The average
age was 43.9 years, the youngest was 21 and the
oldest was 73 years of age. The questionnaires from
people in their 40’s were the highest (33.1%) fol-
lowed by people in their 30’s. 75.6% were married,
21.1% were single and 3.3% were others. Concern-
ing the occupation, specialists and skilled crafts per-
sons were highest in number at 37.2%, followed by
unemployed people 15.7%, clerical and secretarial
workers at 12.4%. Executives, salespersons, agri-
cultural, fisher, construction workers and students
789
were 33.9%. The final academic career being col-
lege level or higher was 50.8% and others were
49.2% (Table 2). The score of each sub-scale of
CCMQ was shown on Table 3.
２．Feasibility
The average time for response was 8 minutes ±
4.2 minutes. The response rates of each of the 60
items varied from 99 to 100%.
３．Reproducibility (Table 4)
The reproducibility of the Japanese CCMQ varied
0.79 to 0.88 for each of the 9 sub-scales and 0.41 to
0.81 for each of the 60 questions.
４．Internal Consistency (Table 5)
The standardized Cronbach’s coefficient varied
from 0.65 to 0.79 for each of the 9 sub-scales.
５．Validity (Table 6)
Regarding the criterion validity, the correlation
coefficient between the 9 sub-scales of the Japanese
CCMQ and SF-36 was 0.46 for the Gentleness type
(P<0.001) and-0.35 to 0.50 (P<0.001) for the rest of
8 sub-scales that were recognized by pathological
constitution types.
790 日東医誌 Kampo Med Vol.59 No.6. 2008
Table 5 Cronbach’s alpha coefficients for nine sub-scales
Ⅳ．Discussions
The constitution classification is the basis of tra-
ditional Chinese medicine. There was a great need
for a questionnaire to enable for evaluating the con-
stitution in a scientifically valid method ; therefore,
a new standardized questionnaire called CCMQ was
developed in Chinese. This questionnaire is clinical
important in the clinical evaluation of Kampo medi-
cine and health promotion before getting diseases.
In order to initiate a cross-cultural project of the
constitution types comparing between China and Ja-
pan, its Japanese version was really necessary to de-
velop. It was developed by a validated linguistic
method.
This questionnaire involves the constitution types
of Gentleness（平和） ，Qi-deficiency（気虚） ，Yang-
deficiency（陽虚） ，Yin-deficiency（陰虚） ，Phlegm-
wetness（痰 湿） ，Wet-heat（湿 熱） ，Blood-stasis
!
（ 血） ，Qi-depression（気鬱）and Special diathe-
（特稟）
sis ．These 9 types of constitution seen in the
CCMQ questionnaire not only based mainly on defi-
ciency, excess, rise and fall of the Yin-Yang and the
Qi, Blood, Body Fluid, but also started from the
view of clinical practices in traditional Chinese
medicine. The constitution classification method has
been widely promoted and applied in China１１）∼１５）.
Thus, the CCMQ questionnaire was constructed on
the basis upon the fundamental concepts that have
been used in traditional Chinese medicine.
With respect to the feasibility of the Japanese
CCMQ, the average response time was 8 minutes
and the response rate of the 60 items was each 99-
100% which was rather high. It was generally said
to be fair if a weighted kappa coefficient is 0.4-
0.75 ; and good if it is 0.75 or greater１６）∼１９）. For
Spearman correlation, it was said to be good if it
was 0.6 or greater１７）１８）. In this study, all the data of
weighted kappa coefficient were greater than 0.4.
Spearman correlation coefficients were greater than
0.6. Both the results showed good reproducibility
for both questions and sub-scales.
Regarding the internal consistency, it was gener-
ally said to be good if Cronbach’s coefficient was
0.7 or greater１６）１７）２０）. In our study, five sub-scales
such as Yang-deficiency type, Yin-deficiency type,
Wet-heat deficiency type, Blood-stasis type, and
Special Diathesis type expressed above 0.7 ; how-
ever, others expressed less than 0.7. Actually, they
were 0.65 for the Gentleness type, 0.65 for the Qi-
deficiency type, 0.66 for the Phlegm-wetness type,
and 0.69 for the Qi-depression type. Thus, the inter-
nal consistency for some of the sub-scales was con-
sidered to be a little bit low but moderately satisfied.
Validity was usually classified by scaling, factor
 日東医誌 Kampo Med Vol.59 No.6. 2008
Table 6 Criterion validity of the Japanese CCMQ with SF-36 components
or construction, criterion, convergent or divergent
validity. In this study, scaling seemed to be fairly
accepted in validity. Factor and convergent/diver-
gent validity was not dealt with. Criterion validity
was evaluated by the comparison with SF-36. Actu-
ally, the healthy type of the constitution such as the
Gentleness was positively correlated with SF-36 and
disease types were negatively correlated as we ex-
pected.
The Japanese version of CCMQ was evaluated to
be acceptable from the viewpoints of feasibility, re-
producibility and some aspects of validity. This
Japanese version should be revised further for a few
questions so that a large scale cross-cultural study of
constitution types would be get started between
China and Japan.
Ⅴ．Acknowledgements
This study was supported by the Major State Ba-
sic Research Development Program of China (973
791
Program) (No.2005 CB 523501) and the Nippon
Foundation.
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